NPIMap

Organization Active NPI

Cantaloupe Holdings, LLC

Doing business as Beachwood Post-Acute & Rehab

  • Skilled Nursing Facility
  • Santa Monica, CA
National Provider Identifier
1295119212
Registry record updated Aug 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
910000016 Issued in CA
Legal business name
CANTALOUPE HOLDINGS, LLC
Doing business as
Beachwood Post-Acute & Rehab
Practice address
1340 15TH St
Santa Monica, CA 90404-1802
Phone
(310) 451-9700
NPI assigned
Jul 20, 2015
Last updated
Aug 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
John Mitchell
Title
Secretary
Phone
(385) 988-3319

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 910000016 CA Primary

Addresses

Primary practice location

1340 15TH St
Santa Monica, CA 90404-1802

Mailing address

262 N University Ave Ste 200
Farmington, UT 84025-2975

Other identifiers 1

IdentifierTypeStateIssuer
1801836622MedicaidCA

Other names 1

  • Beachwood Post-Acute & Rehab Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151030002057 CA Part A Provider - Skilled Nursing Facility 5496065666 Practice locations: Santa Monica, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295119212. Details of each certification follow.

Skilled nursing facility certification: CCN 056334

Legal name
CANTALOUPE HOLDINGS LLC
Doing business as
BEACHWOOD POST-ACUTE & REHAB
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 14, 1972
Last certification
Jun 28, 2024
Beds
227
Ownership / control type
Limited Liability Corporation
Multi-facility organization
PACS
Organization structure
LLCProprietary
Incorporated
Jun 30, 2015 in DE
Enrollment address
1340 15TH St
Santa Monica, CA 90404-1802
Nursing home name
BEACHWOOD POST-ACUTE & REHAB
Affiliated entity
PACS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Beachwood Post-Acute & RehabCCN 056334 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
3 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jul 14, 1972
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
227210.8 residents per day on average
Chain
Pacs Group274 facilities in the chain
Penalties (3 years)
3Fines totaling $177,718

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2295975Beachwood Post Acute & Rehab1340 15TH St, Santa Monica, CA 90404Certificate of waiverDec 18, 2027

National Provider Directory

National Provider Directory

Locations

262 N University Ave
Ste 200
Farmington, UT 84025

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Providence Group Inc Organization, Farmington, UT Corporation, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Nov 5, 2021 100%
Jason H Murray Individual 5% Or Greater Indirect Ownership Interest Apr 15, 2024 41.8%
John T Mitchell Individual Corporate OfficerSecretary Jan 1, 2024
Chandandeep S Cheema Individual Contracted Managing EmployeeMD; Nov 5, 2021
Frederick G Apt Individual Corporate OfficerTreasurer Jan 1, 2024
Pacs Holdings, LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Indirect Ownership Interest Jun 30, 2023 100%
Joshua O Jergensen Individual Corporate OfficerPresident Jan 1, 2024
Pacs Group, Inc. Organization, Farmington, UT Corporation, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Jun 30, 2023 100%
Opco Holdings LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Indirect Ownership Interest Dec 1, 2015 100%
California Opco LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Direct Ownership Interest Dec 1, 2015 100%
Bay Bridge Capital Partners, LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Indirect Ownership Interest Aug 15, 2014 100%
Anton Novitsky Individual W-2 Managing EmployeeAd; Jan 1, 2017
Mark D Hancock Individual 5% Or Greater Indirect Ownership Interest Apr 15, 2024 41.8%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 81

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 81

Practitioners & affiliated clinicians

Affiliated clinicians 12

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1437350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724025600000",
    "number": "1295119212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "262 N UNIVERSITY AVE STE 200",
            "city": "FARMINGTON",
            "state": "UT",
            "postal_code": "840252975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1340 15TH ST",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904041802",
            "telephone_number": "310-451-9700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANTALOUPE HOLDINGS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-20",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "385-988-3319"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "910000016",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1801836622",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beachwood Post-Acute & Rehab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Monica, CA

Sources for this page

Verify at the official NPI Registry.